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General NPI Number Information
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NPI Number | 1972864320
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Entity Type | Organization
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Legal Business Name | JEFFERY D. WILFONG, MARRIAGE, CHILD, AND FAMILY COUNSELING, INC.
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 900 FULTON AVE STE 270
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City | SACRAMENTO
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State | CA
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Zip | 95825-4516
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Country | US
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Telephone | 888-511-4269
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Fax | 888-511-4258
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Provider Business Mailing Address
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Address Line | PO BOX 191381
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City | SACRAMENTO
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State | CA
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Zip | 95819-1381
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Country | US
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Telephone | 888-511-4269
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Fax | 888-511-4258
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFERY DOUGLAS WILFONG
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Credential | MFT
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Telephone | 888-511-4269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFCC 46654
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License Number State | CA
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